门静脉高压患者肝脏超声造影参数与门静脉压力相关性研究

Correlative study between parameters of CEUS and portal vein pressure in patients with portal hypertension

目的应用超声造影检测门静脉高压患者肝内血流灌注相关参数,探讨其与门静脉压力的相关性及在门静脉高压中的应用价值。方法选择经临床诊断为门静脉高压并需要手术治疗的33例患者,其中男性24例,女性9例;年龄25~62岁,平均年龄49.67岁;Child-Pugh分级A级14例,B级17例,C级2例。于术前行超声造影检查。记录造影剂肝动脉到达时间(HAAT)、肝静脉到达时间(HVAT)、门静脉到达时间(PVAT),计算肝动静脉渡越时间(HA-VTT)、门静脉-肝静脉渡越时间(PV-HVTT)等造影参数,绘制时间-强度曲线;并在术中未行分流或阻断术前通过胃网膜右静脉测量门静脉压力,探讨上述造影参数与门静脉压力、Child-Pugh分级及食管静脉曲张程度的相关性。结果门静脉高压患者门静脉压力越高,HA-VTT、PV-HVTT呈逐渐降低趋势(r=-0.724、-0.764,P=0.000、0.000);食管静脉曲张重度组PV-HVTT[(-1.22±2.61)s]较轻-中度组PV-HVTT[(2.83±3.91)s]明显缩短,差异有统计学意义(P<0.05);食管静脉曲张重度组门静脉压力[(3.59±0.81)k Pa]明显高于轻-中度组门静脉压力[(2.91±0.66)k Pa],差异有统计学意义(P<0.05);Child-Pugh B级组HA-VTT[(4.02±2.35)s]较A级组HA-VTT[(7.47±1.22)s]明显缩短,差异有统计学意义(P<0.05)。结论超声造影参数特别是HA-VTT、PV-HVTT与门静脉压力有良好的相关性,超声造影能够较好地评估门静脉高压。

Objective To detect intrahepatic blood perfusion related parameters in patients with portal hypertension by contrast-enhanced ultrasound（CEUS）, and investigate its application value in portal hypertension and correlation with portal vein pressure. Methods A total of 33 cases of patients with portal hypertension who needed surgical treatment were enrolled, which included 24 males and 9 females, aged 25-62 years old with mean age of 49.67 years old. By Child-Pugh grading, 14 cases were grade A, 17 of grade B and 2 of grade C. The CEUS was performed before operation. The arrival time in hepatic artery（HAAT）, hepatic vein（HVAT） and portal vein（PVAT） were recorded and hepatic artery and portal vein transit time（HA-VTT）,portal vein hepatic vein transit time（PV-HVTT） were calculated, respectively, and time intensity curve were drawn. The por-tal vein pressure of right gastric vein was measured during the operation before shunt or block. The correlation between the parameters of CEUS and portal vein pressure, Child-Pugh grading and esophageal varices were investigated. Results In portal hypertension patients, the portal pressure were increased while the PV-HVTT and HA-VTT were gradual decreased（ r =-0.724,-0.764, P = 0.000, 0.000）. The severe esophageal varices group of PV-HVTT was（-1.22 ± 2.61） seconds, which was significantly shorter than the mild-moderate group[（2.83 ± 3.91） seconds]（P〈0.05）. The severe esophageal varices of portal venous pressure[（3.59 ± 0.81） k Pa] were statistically significantly higher than that of mild-moderate group[（2.91 ± 0.66） k Pa]（P〈0.05）. The Child-Pugh grade B HA-VTT[（4.02 ± 2.35） seconds] was statistically significantly shorter than that of grade A HA-VTT [（7.47 ± 1.22） seconds]（P〈0.05）. Conclusion It is demonstrated that there is a good correlation between the parameters of CEUS and portal venous pressure, CEUS could be used to evaluate portal hypertension.